With Apologies to Christopher Nolan

Spoiler alert: don’t read this if you haven’t watched Inception!

SAITO: I’ve seen one before. Many, many years ago.

The elderly Japanese man picks up the cone between thumb and forefinger. He spins it onto a table - it circles gracefully across the polished ebony…a spinning top.

SAITO: It belonged to a man I met in a half-remembered dream. A man possessed of some radical notions…

COBB: What’s the most resilient parasite?

The speaker, Cobb, starts his pitch. Handsome, well-dressed, persuasive. With such a knack for selling, it is anyone’s guess why he is here and not drowning in cash in the middle of Wall Street.

COBB: A bacteria? A virus? An intestinal worm?

ARTHUR: The rat lungworm, actually. It can migrate to your brain!

A confused silence follows. Cobb glares at his partner, Arthur. With a face that exclaims “I belong in high school!” it is anyone’s guess what he is doing in a professional extraction operation. Cobb collects himself and continues the pitch.

COBB: Well, yes, indeed. More importantly, what’s the best antiparasitic? Mr. Saito, I believe you know the answer, because your company-

SAITO: Placebo. The best antiparasitic is placebo.

Saito cuts him off. Cobb and Arthur freeze.

SAITO: Let’s drop the act, OK? I know this is a dream and that you’re here to steal the formula for my new drug. Good luck getting it from here. I don’t even know it. I’m a CEO, not a chemist.

Cobb glares at Arthur again. Arthur shrugs and lets out a nervous chuckle. Both of them reach for their pistols.

COBB: Well, you’ve caught us. Time to wake-

SAITO: Not so fast.

Saito hallucinates two pairs of handcuffs into existence, restraining the conmen’s wrists.

SAITO: I have a better job for you. I’ve heard you’re pretty famous for helping get results in clinical trials. We have several compounds about to undergo phase III at the moment. I think my company would benefit from your services.

COBB: What do you want from us?

SAITO: Inception.

COBB: You know how when you get shot in a dream, you either wake up in reality or you drop into limbo?

ARIADNE: I’ve watched the movie, yes.

Ariadne, a young college student, sits across Cobb in a café in the middle of Paris.

COBB: The real question is why this happens. A dream is a dream, isn’t anything supposed to be possible? Why wouldn’t bullets just naturally bounce off of you like rubber? Or even if they did pierce your dream body, why would that kill you?

ARIADNE: I don’t know, why?

COBB: That is because you anticipate bullets are going to kill you. You die in a dream if and only if you believe that you are going to die. So bullets are really nothing more than concentrated belief that you are going to die.

ARIADNE: Go on.

COBB: So what happens when we flip this around and look for concentrated belief that you are going to heal?

ARIADNE: Oooooooooh.

Ariadne produces a bottle of medicine from her purse and stares at it. Suddenly, a wince takes a hold of her expression, and she takes her right hand to her temple. She looks uncomfortable.

COBB: Are you getting a migraine? Maybe you should take some of your meds.

Ariadne drops a tablet to her hand. She throws it into her mouth and gulps it down with a swig from her coffee. She immediately brightens up.

COBB: Works like a charm, doesn’t it? Maybe a little too well?

ARIADNE: Yeah, now that you mention it, it usually takes longer to kick in.

COBB: Interesting, isn’t it? By the way, you know how dreams feel real when we’re in them? Let me ask you a question: how did we end up at this restaurant?

ARIADNE: Well we just came from the…ohmigod. Is this a dream?

Cobb and Ariadne jolt awake - they are sitting comfortably in lawn chairs in an old workshop, IVs hooked into their arms. Arthur watches over them.

COBB: Taking hallucinatory medicine in a hallucinatory world feels like the real thing, doesn’t it?

ARTHUR: Remember how we sedate ourselves in a dream to be able to dream within a dream? Pretty powerful effect for hallucinatory benzos, no?

ARIADNE: I get you can make yourself believe you’re curing your pain or whatever inside the dream, but what are you planning to do with it?

COBB: We have perfected the art of planting ideas in people’s minds. So much that we’re now getting paid per subject incepted. Pharmaceuticals are one of our most frequent employers. We pose as clinical staff evaluating subjects in clinical trials. We then share a dream with every subject in the experimental group, go in deep into their subconscious, and plant in their minds a very simple idea.

ARTHUR: That the medicine is going to cure them.

ARIADNE: Hold on. Isn’t that blatantly falsifying the data?

COBB: Do you know how many millions of dollars are spent in drug design? How many years are spent in development and approval of a single drug? Instead of investing so much in chemical efficacy, why not invest in creating better placebo effects?

ARTHUR: Do you know how effective a well-made placebo can be? It can have a Cohen’s d of 1. That’s the same effect size of oxycodone for pain, levodopa for Parkinson’s, and much, much higher than aspirin or statins for cardiovascular prevention.

ARIADNE: Okay, say we hack the trial results by manipulating the experimental group to give us a huge effect size. The drug gets to the market, people start taking it, they find out it doesn’t work. Won’t they find out the trial results were manipulated?

COBB: Ah, but we’re creating a drug that works. See, people are more than happy to put their faith in anything that’s just a mere possibility. Why would you get such a strong placebo effect from pills if you know they contain but a microscopic amount of active substance? Because someone long ago proved that it’s possible for a microscopic amount of substance to cause drastic effects in your body. Why do some people swear by their beloved mothers that 5G messed up their brains? Because we know that it is possible for things that shoot invisible waves at people’s heads to mess with their brains.

ARTHUR: Besides, we’ve actually done this before lots of times. How do you think it’s possible for one of the most prescribed drug classes on the planet to simultaneously be the object of a raging debate on whether it is placebo or not, and at the same time generate millions of dollars for pharmaceutical companies?

ARIADNE: I can’t believe this! You mean to tell me that in the end SSRIs have always been placebo?

COBB: Not only SSRIs, but yes. Don’t fret though! Evidence-based medicine says you look at the outcomes, not the mechanisms. Even when you know that a medicine is placebo, it can still have statistically significant effects. So SSRIs should still work on you without issue.

ARIADNE: That’s a boatload of poppycock! Tell me the truth. How many of the medicines we use are actually nothing more than placebo? How many human lives have you ruined by denying them appropriate treatment?

COBB: Calm down. I’ll say it again, it’s actually the most appropriate treatment there is. In fact, why don’t you see for yourself? You always carry a bottle of headache pills with you, don’t you? Anything you believe they can do, they might be able to do for you.

Ariadne produces a bottle of medicine from her backpack and drops a tablet into her hand.

ARIADNE: Well, I choose to believe this medicine will give me enough clarity to see through the baloney you’re spouting right now!

After her fervent declaration, Ariadne forcefully gulps the pill without water.

♪ Non, rien de rien
Non, je ne regrette rien ♪

The clarity comes in the form of the faint, but definitely real singing voice of Edith Piaf inside Ariadne’s head. Her expression becomes blank as the placebo-induced song becomes a realization. The power of placebo. Placebo-induced epistemologies. Placebo-induced epistemologies about placebo. Metaplacebo epistemology. That’s it. What if all medications are –

♪ Ni le bien qu’on m’a fait
Ni le mal
Tout ça m’est bien égal ♪

Ariadne takes off her earbuds. The movie is still playing on her screen. “So this is what happens when you fall asleep watching Inception,” she thinks to herself. The concept of totems was alive in her memory, but she never expected to see it with a bunch of pills.

Ladies and gentlemen, welcome to Los Angeles International Airport. The local time is 10:35 AM. On behalf of our crew, we thank you for flying with us today and look forward to seeing you in your next flight.

A headache suddenly assaults her. It is one of the bad ones, the kind of wake-up headache that makes the rest of the day miserable. She rummages through her bag frantically until she finds a medicine bottle. As she unscrews the cap and grabs a tablet, she stops in her tracks. Ariadne contemplates the pill intently, as if reality and ethics were condensed in this little object on the palm of her hand.

And then, she is not sure, but for a microsecond she thinks she recognizes someone out of the corner of her eye. A man who looks like he belongs in high school, suitcase in hand. And behind him - maybe her eyes are just dry, or maybe she is still groggy and migrainous - the handsome, persuasive face of Leonardo DiCaprio, turning around quickly as he walks the narrow aisle of the plane to disembark.